An updated estimate of posttransplant survival after implementation of the new donor heart allocation policy. Issue 6 (6th January 2022)

• Record Type: Journal Article
• Authors: Lazenby, Kevin A.; Narang, Nikhil; Pelzer, Kenley M.; Ran, Gege; Parker, William F.
• Is Part Of: American journal of transplantation. Volume 22:Issue 6(2022)
• Page Start: 1683
• Page End: 1690
• Publication Date: 2022-01-06
• Subjects: health services and outcomes research -- heart transplantation/cardiology -- Organ Procurement and Transplantation Network (OPTN) -- patient survival -- registry/registry analysis -- Scientific Registry for Transplant Recipients (SRTR) -- statistics; Transplantation of organs, tissues, etc -- Periodicals; 617.95
• DOI: 10.1111/ajt.16931
• Languages: English
• ISSNs: 1600-6135

Abstract

Abstract : The Organ Procurement and Transplant Network (OPTN) implemented a new heart allocation policy on October 18, 2018. Published estimates of lower posttransplant survival under the new policy in cohorts with limited follow‐up may be biased by informative censoring. Using the Scientific Registry of Transplant Recipients, we used the Kaplan–Meier method to estimate 1‐year posttransplant survival for pre‐policy (November 1, 2016, to October 31, 2017) and post‐policy cohorts (November 1, 2018, to October 31, 2019) with follow‐up through March 2, 2021. We adjusted for changes in recipient population over time with a multivariable Cox proportional hazards model. To demonstrate the effect of inadequate follow‐up on post‐policy survival estimates, we repeated the analysis but only included follow‐up through October 31, 2019. Transplant programs transplanted 2594 patients in the pre‐policy cohort and 2761 patients in the post‐policy cohort. With follow‐up through March 2, 2021, unadjusted 1‐year posttransplant survival was 90.6% (89.5%–91.8%) in the pre‐policy cohort and 90.8% (89.7%–91.9%) in the post‐policy cohort (adjusted HR = 0.93 [0.77–1.12]). Ignoring follow‐up after October 31, 2019, the post‐policy estimate was biased downward (1‐year: 82.2%). When estimated with adequate follow‐up, 1‐year posttransplant survival under the new heart allocation policy was not significantly different. Abstract : This study demonstrates how early reports of decreased posttransplant survival under new donor heart allocation policy were statistically biased by limited follow‐up data and finds that with more complete follow‐up data, post‐transplant survival is not significantly different between policy periods. Massie et al. comments on page 1513